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slide0001_image001 40° Annual Conference International Academy of Sex Research

Dubrovnik, Croatia, June 25-28, 2014

Body Image in Women with Breast Cancer at Surgery and Two Decades later: Therapeutic Strategies for Sexual Rehabilitation

slide0001_image003Breasts mean identity, attractiveness, sexuality, and motherhood but cancer changes forever  the way a woman looks at them: a deadly illness is nestled there and the surgical scar will not allow to forget.

The emotional reaction to the scar was explored in 50 lumpectomized  women.

Twenty-eight women were menstruating, mean age was 43 yrs (28-52) and mean relationship duration was  18 yrs (7-29); the remaining 22 were menopausal, mean age was 59 (45-72) and mean relationship duration was 35 yrs (23-46).

The women were interviewed twice, at 6-8 weeks and 17-18 years after surgery.

During the first interview, they showed a bitter attitude towards the breast aesthetic appearance and the scar. Understanding that surgery saved their lives did not facilitate acceptance. Anger and refusal were so strong that the women did not let their husbands look and fondle their breasts and the emotional discomfort brought about by the body image disruption prevented them to resume love making. The women could not imagine to include the operated breast in an erotic context because it witnessed a dreadful condition and it did not feel like their own any more, therefore it could not be associated with joy and playfulness.

slide0001_image006Of course, sexual abstinence was also due to the physical strain of surgery and chemotherapy and to the impact of the illness on mood and desire.

The therapeutic strategy used to help these women to resume sex supported their need to keep breasts hidden from sight; that was achieved by means of sexy lingerie, camisoles, or slips that the women wore before lovemaking.  Although very simple, this intervention was crucial to help them feel sexy again.

slide0001_image004The same cohort was contacted 17-18 yrs later:

31 women could not be traced, 6 died of cancer or other causes, 6 refused and 7 accepted to be interviewed. Mean age was 61 yrs (50-70); mean relationship duration was 36 yrs (28-47).

They told me how happy they were that cancer was defeated and grateful for the years they had not expected to live, but none had forgiven the surgical scar. All patients laughed with me when they said their breasts were no longer so attractive and aesthetics did not mean much any more. Still, none of them had forgotten what the scar meant or had ever made love in the nude again.

Anna Ghizzani, MD